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Role Description

We are seeking a detail-oriented Personal Injury Protection Resolution Specialist to join our teams. The PIP Resolution Specialists will be responsible for investigating and evaluating PIP / MP claims and coverage.

• Handle an inventory of PIP claims and deliver service to all constituents of the claim.
• Collaborate closely with product and engineering teams to give feedback and identify technology and process improvements.

Qualifications

• Bachelor's degree (lack of one should not stop you from applying if you possess all the other qualifications)
• Minimum of 3 years of experience on point and concentrated in Personal Injury Protection, ideally experience with:
• Handling the states of NY, NJ, MI, FL and/or KY.
• Handling of commercial, ride share or trucking policies is highly preferred.
• Understanding of how to handle subrogation referrals.
• Bodily Injury and coordination of benefits between PIP and UM / UIM.
• Arbitration and or formal PIP/MP litigation.
• Have active adjuster license(s) and be willing to obtain all licenses within 45 days, including completing state required testing (must already have your home state license).
• Knowledge of state regulations, policy provisions, and standard operating procedures.
• Ability to analyze and evaluate complex data and make sound decisions based on established guidelines, policies, and procedures.
• Curious and motivated by problem solving and questioning the status quo.
• Desire to engage in learning opportunities and continuous professional development.
• Willingness to travel for client and claims needs.

Requirements

• Provide prompt, courteous and high-quality customer service to all policyholders and claimants by answering customer calls, filing claims, and resolving customer requests.
• Investigate PIP / MP claims to determine coverage, extent of injury and evaluate medical billing for necessity and relatedness to the claim.
• Gather relevant documentation, interview involved parties, explain policy, coverage, and appropriate course of action and resolve related medical expenses.
• Assess the validity of PIP claims based on collected evidence, medical records, and applicable laws.
• Determine the appropriate settlement amount if appropriate, ongoing plan for resolution and recommend further action if necessary.
• Manage an inventory of claims, establish initial reserves for all potential exposures, and adjust as appropriate throughout the claim.
• Ensure compliance with specific state regulations, policy provisions, and standard operating procedures.
• Maintain regular communication with claimants, policyholders, attorneys, medical providers, and other relevant parties to provide updates on claim status, request additional information, and facilitate the claims process within approved payment authority.
• Prepare thorough and accurate claim reports, including detailed summaries of investigation findings, evaluation of damages, and rationale for claim decisions.
• Provide input for continuous development of claims guidelines, best practices, and process improvements.
• Oversee and direct outside investigative service providers and work closely with the client and client counsel and investigative services to resolve the claim.
• Engage in learning opportunities to build knowledge of commercial lines claims, court decisions impacting the claims function, current guidelines in claims function, and policy changes and modifications.

Benefits

• Generous health-insurance package with nationwide coverage, vision, & dental.
• 401(k) retirement plan with employer matching.
• Competitive PTO policy – we want our employees fresh, healthy, happy, and energized!
• Generous family leave policy after 8 months of continuous work.
• Work from anywhere to facilitate your work life balance.
• Apple laptop, large second monitor, and other quality-of-life equipment you may want.
• Listen to your feedback to enhance and improve upon the long-standing challenges of an adjuster and the claims role.
• Work toward reducing and eliminating all the administrative work from an adjuster role.
• Foster a culture of empathy, transparency, and empowerment in a remote-first environment.